Laserfiche WebLink
APPLICATION FOR SANITATION PERMIT Permit No.._+_____.:. <br />(Complete in Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />Date Issued ____�.__._�. <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with <br />Count y Or�anceo.9.vu �JOB ADDRESS AND. OC . 10 ------ ------ - --- - <br />-------------- - ------------------------------------------------------ <br />Owner's Name ---------- --------------------------------•----------------------------------------- Phone ------------------------------------ <br />Address-----------Z/7/j'-- ' <br />Contractor's Name--- ---- - -- -- - ---- --•-------------------------------------------------------------------------------------- Phone------- ----------•---------------- <br />Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other <br />Number of living units: ______ Number of bedrooms _. ------ Number of baths __ Lot size _____________ _______________ <br />Wafer Supply: Public system [—]Community system E] Private F-1Depthto Water Table _16'___ft. <br />Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy-LoamClay Loam �] Clay ❑ Adobe E]Hardpan E] <br />Previous Application Made: Yes ❑ No ❑ New Construction: iYes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br />TYPE OF INSTALLATION AND SPECIFICATIONS: iD 1 <br />(No septic tank or cesspool permitted if public sewer is available within100 feet.). <br />Septic Tank: Distance from nearest well --- ________Distance from foundation__..1.e_____.__.MateriaL_, <br />No: of compartments ------- rr _---____---Size- _---_ Liquid depth ---------------Capacity___ ........... <br />_ - r / <br />Disposal Feld: Distance from nearest well .��;-- Distance from foundatio ---- Distance to nearest lot line______ <br />[T gth of each �! <br />Number of lines___:___ _________________ en <br />' p �------- Width of trench---..�r�--------------------- <br />Type <br />- ------------- <br />Type of filter material A;_ !T %i_ Depth of filter; material_____ ._-____ Total 'length-__.__ _:___________.__________ <br />Seepag it: Distance to nearest well ---------------------- Distance from foundation -------------------- Distance to nearest lot line_________________ <br />orNumber of pits ------ ---------------- Lining material ----------------------- Size-. Diameter -----------------_---. Dept h ------------------------ --------- <br />Cesspool: Distance from nearest well ----------------- Distance from foundation ------------- .------- Lining material__.___,------------------------------- <br />El <br />.._.-__-_______.__________-_.❑ Size: Diameter------ ------------------------------- Depth ---------------------------------------------------- Liquid Capacity_. ------------------------ gals. <br />Privy: Distance from nearest well ------------------------------------------------- Distance.from nearest building ------------------- _____________..___._. <br />❑ Distance to nearest lot line -------- - - - <br />and/or repairing escribe)------------------------- -----------------••- <br />Remodeling- ' <br />:- : -------------- --------------------- -------------------------------- <br />----------- ------------------- -------------------- <br />------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br />I hereby certify,that I have prepared this application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br />(Si ned---------------' <br />9 I----------------------- � ------ - - -.---- --- - - ------------- r Contractor{ <br />By:--------------------------------------------------------------- ;------------------------------------------------ <br />{Title) '� <br />--------------- ------ ------ ---- <br />---------------- - - f�' lr-7r°/sem"-�------------------------ -- -- <br />(Plot plan, showing size of lot, location of system n relation to wells, buildings,'etc., can be placed on reverse side). <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ___._�-i ` C ----------------- - C --------- <br />------------------ - ----•-----------.DATE------�-��-�---- <br />REVIEWEDBY --------------- ---------------------------­ ----------------------------------------- ------------------------------------- DATE-------- <br />- -- ------------------------- <br />BUILDING PERMIT ISSUED-------•-----------:---------------------------------------------------------------------------------- DATE -------------------------- - <br />- - ----------------------------- <br />Alterationsand/or recommendations---------------------------------------- -------------------------------------=--------------•-•------------------------------------------------------------ <br />--------------------------------------------------------------------------------------------------------------------------------------------------------•------ -----------••---------------------------------------- <br />FINAL INSPECTIO Date -------- __ - . <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Stockton, California Lodi, California Manteca, California Tracy, California <br />ES -9-2M Revised 8-'59 P.P.Co. <br />